TV Before Bed May Rob Kids of Sleep

The more TV children watch before bedtime, the less sleep they get, researchers found.

Action Points

The more TV that kids watch before bedtime, they less sleep they get.

Note that although causality could not be inferred from this study, it suggests that reducing screen sedentary time may be an appropriate intervention for promoting earlier sleep onset in young people.

The more TV children watch before bedtime, the less sleep they get, researchers found.

In a cross-sectional sample of children and teens from New Zealand, roughly 30 minutes of the 90 minutes before participants went to sleep each night were spent in sedentary screen-time (TV, video games, computers), according to Louise Foley, PhD, of the University of Auckland in New Zealand, and colleagues.

Those who spent the most time in front of a screen were more likely to go to sleep later than those who were engaged in nonscreen sedentary activities before bed, they wrote online in Pediatrics.

Sleep duration in younger people has declined rapidly over the past 100 years, they noted, adding that inadequate sleep is associated with behavior and health issues in this younger population. Although they cautioned that causality could not be inferred from their cross-sectional study, they added that teens' and children's presleep time in front of a video screen "may be implicated through disrupting or displacing sleep."

To investigate associations between activities, children and teens engage in 90 minutes before sleep and time to sleep onset, the researchers used data from a nationally representative, cross-sectional survey of New Zealand children and teens, ages 5 to 18. Participants were interviewed in-person and then follow-up was done through telephone interviews between September 2008 and May 2009.

Baseline face-to-face interviews gathered information on participant characteristics and 1 to 2 days of data on use of presleep time. The follow-up gathered 2 additional days of data. Younger children's parents would assist with recalling activities when necessary.

Participants reported time of sleep onset, sedentary behavior, physical activity, and self care during the 90 minutes before sleep by selecting from a list of roughly 250 activities. Activities were given energy costs and psychometric properties, and were recounted with time spent engaged in each activity.

Times of sleep onset were categorized as very early, early, late, and very late. Participants were grouped by ages 5 to 12 and 13 to 18.

A total of 2,017 survey participants were included in the current analysis. The mean age was 11.6, just over half were male (52.9%), and most were of New Zealand European ethnicity (71.4%).

Overall, younger participants went to bed earlier than older ones. The most common activities before bed were watching television while sitting (47.8%), dressing/undressing before bed (41.8%), and brushing one's teeth (41.5%), and all were considered low-intensity activities (metabolic equivalents ranging from 1 to 2).

"In New Zealand, a maximum of 2-hours of screen time per day is recommended for young people," the authors noted, adding that the roughly half hour of screen time before bed accounted for one quarter of a child's daily recommended screen time.

They also found that participants who reported later sleep onset also reported up to 13 more minutes of screen time before bed than those who went to bed earlier.

Additionally, early sleep onset was associated with significantly less time in screen-based sedentary activity versus later sleep onset (P<0.001).

Differences in screen time differed by 4 to 13 minutes between early and late sleep onset groups. Those who went to bed earlier also spent more time engaged in nonscreen sedentary behaviors, although differences between late and early sleepers varied by clinically nonsignificant 5 to 8 minutes for these activities.

"The largest mean time differences between those of early and late sleep onset were for screen time, which suggests that this set of activities may be an appropriate target for interventions to promote earlier sleep onset and subsequently improve sleep duration in young people," Foley and colleagues concluded.

The authors found their research may be limited by a 45% nonparticipation rate and biases associated with self-reported data.

The study was funded by Sport and Recreation New Zealand, the Ministry of Health, the Ministry of Education, and the Ministry of Youth Development.

Foley recieved support from the Tertiary Education Commission Bright Futures Doctoral Scholarship and the Heart Foundation of New Zealand Postdoctoral Fellowship.

One co-author received support from the Heart Foundation of New Zealand Fellowship and the Health Research Council of New Zealand Sir Charles Hercus Health Research Fellowship.

Another co-author received support from the University of Auckland Doctoral Scholarship.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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